Several studies using a preparation based on faecal tagging have been performed. The results of polyp detection of these studies are listed in Table 4.1.

Thomeer et al. (2003) examined 150 patients and performed colonic cleansing using 3-5 L of an electrolyte solution on the day of CT colonography. Faecal tagging was obtained with 90-150 ml of iodi-nated contrast. As they were starting CT colonogra-phy in their department the results of polyp detection were clearly influenced by the learning curve. They divided the study group into 2 groups of 75 patients each. Sensitivity was clearly better in the second group of patients.

Pineau et al. (2003) prepared patients the day before CT colonography combining a double dose of oral sodium phosphate (2x45 ml) with 30 ml of iodine and obtained good results of polyp detection.

Lefere et al. (2002) and Lefere and Gryspeerdt (2005) have performed two feasibility studies with

Table 4.1. Table showing the results of polyp detection on a per patient basis

n patients

>6 mm

>1 cm

Thomeer et al. (2003)







All (150)



Pineau et al. (2003)




Lefere et al. (2002)




Lefere et al. (2005)




Pickhardt et al. (2003)




faecal tagging testing barium as the sole tagging agent. In a first study 50 patients were prepared with the low residue diet and the mild cathartic cleansing as described above. Faecal tagging was obtained with 3x250 ml of a 2.1% w/v barium suspension. In the second study 180 patients underwent faecal tagging with a 40% w/v barium suspension. In both studies good results of polyp detection were obtained.

Last but not least, PickhardT et al. (2003) obtained the best results of polyp detection to date with virtual colonoscopy in a large cohort of 1233 asymptomatic patients. The day before CT colonography they combined a clear liquid diet with a double dose of oral sodium phosphate and two bisacodyl tablets. Faecal tagging was performed with 2x250 ml of a 2.1% w/v barium suspension and 60 ml of Gas-trografin. Excellent results of polyp detection were obtained.

The American Food and Drug Administration (FDA 2001) considers the double dose of oral sodium phosphate as an off-label use and warns not to exceed the recommended 45 ml dose. It says that people at increased risk for electrolyte disturbances (e.g. congestive heart failure, renal insufficiency, dehydration) may experience serious adverse effects using oral sodium phosphate. They advise obtaining baseline serum electrolyte values in patients ingesting more than 45 ml of oral sodium phosphate in a 24-h period in order to avoid serious electrolyte problems.

Pickhardt (Hinshaw et al. 2005) now uses two bisacodyl tablets and a single dose of oral sodium phosphate as cathartic cleansing combined with

250 ml of the 2.1% barium suspension and 60 ml of Gastrografin to prepare the patients for CT colonog-raphy.

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